Provider Demographics
NPI:1033512470
Name:MULLANEY, DAN RUSSEL (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:RUSSEL
Last Name:MULLANEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 FALCON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2417
Mailing Address - Country:US
Mailing Address - Phone:972-957-7539
Mailing Address - Fax:972-943-0997
Practice Address - Street 1:1607 FALCON DR STE 102
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:972-957-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor